RemoteWorker US
Remote Child & Adolescent Behavioral Medical Director - Washington
RemoteWorker US, New York, New York, United States
Remote Child & Adolescent Behavioral Medical Director - Washington
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Remote Child & Adolescent Behavioral Medical Director - Washington
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RemoteWorker US Get AI-powered advice on this job and more exclusive features. You could be the one who changes everything for our 28 million members as a clinical professional on our Medical Management/Health Services team. Centene is a diversified, national organization offering competitive benefits including a fresh perspective on workplace flexibility. Position Purpose:
Assist the Chief Medical Director in directing and coordinating the medical management, quality improvement, and credentialing functions for the business unit. Responsibilities:
Provide medical leadership for utilization management, cost containment, and medical quality improvement activities. Perform medical review activities related to utilization review, quality assurance, and medical review of complex, controversial, or experimental medical services, ensuring timely and quality decision-making. Support effective implementation of performance improvement initiatives for capitated providers. Assist the Chief Medical Director in planning and establishing goals and policies to improve quality and cost-effectiveness of care and services for members. Provide medical expertise in the operation of quality improvement and utilization management programs in accordance with regulatory, state, corporate, and accreditation requirements. Assist in the functioning of physician committees, including structure, processes, and membership. Conduct regular rounds to assess and coordinate care for high-risk patients, collaborating with care management teams. Collaborate with clinical teams, network providers, appeals teams, and consultants for reviewing complex cases and appeals. Participate in provider network development and market expansion as appropriate. Assist in developing and implementing physician education on clinical issues and policies. Identify utilization review studies and evaluate adverse trends and provider practice patterns. Identify clinical quality improvement studies to reduce unwarranted practice variation and improve care quality and cost. Interface with physicians and providers to facilitate implementation of recommendations. Review claims involving complex or unusual services to determine medical necessity and payment accuracy. Develop alliances with the provider community through medical management programs. Represent the business unit before public and professional committees as needed. May work weekends and holidays to support operations. Education/Experience:
Medical Doctor or Doctor of Osteopathy. Experience in Utilization Management and knowledge of accreditation standards preferred. Active medical practice required. Coursework in Health Administration, Financing, Insurance, or Personnel Management is advantageous. Experience with diverse populations preferred. License/Certifications:
Board certification by the American Board of Psychiatry and Neurology. Current Washington state medical license without restrictions. Compensation & Benefits:
Pay Range: $231,900.00 - $440,500.00 per year. Benefits include competitive pay, health insurance, 401K, stock plans, tuition reimbursement, paid time off, holidays, and flexible work arrangements. Actual pay may vary based on skills, experience, and other factors. Total compensation may include incentives. Additional Information:
Centene is an equal opportunity employer committed to diversity. All qualified applicants will be considered without regard to race, religion, gender, sexual orientation, gender identity, national origin, disability, veteran status, or other protected characteristics. Qualified applicants with criminal records will be considered in accordance with applicable laws. #J-18808-Ljbffr
Join to apply for the
Remote Child & Adolescent Behavioral Medical Director - Washington
role at
RemoteWorker US Get AI-powered advice on this job and more exclusive features. You could be the one who changes everything for our 28 million members as a clinical professional on our Medical Management/Health Services team. Centene is a diversified, national organization offering competitive benefits including a fresh perspective on workplace flexibility. Position Purpose:
Assist the Chief Medical Director in directing and coordinating the medical management, quality improvement, and credentialing functions for the business unit. Responsibilities:
Provide medical leadership for utilization management, cost containment, and medical quality improvement activities. Perform medical review activities related to utilization review, quality assurance, and medical review of complex, controversial, or experimental medical services, ensuring timely and quality decision-making. Support effective implementation of performance improvement initiatives for capitated providers. Assist the Chief Medical Director in planning and establishing goals and policies to improve quality and cost-effectiveness of care and services for members. Provide medical expertise in the operation of quality improvement and utilization management programs in accordance with regulatory, state, corporate, and accreditation requirements. Assist in the functioning of physician committees, including structure, processes, and membership. Conduct regular rounds to assess and coordinate care for high-risk patients, collaborating with care management teams. Collaborate with clinical teams, network providers, appeals teams, and consultants for reviewing complex cases and appeals. Participate in provider network development and market expansion as appropriate. Assist in developing and implementing physician education on clinical issues and policies. Identify utilization review studies and evaluate adverse trends and provider practice patterns. Identify clinical quality improvement studies to reduce unwarranted practice variation and improve care quality and cost. Interface with physicians and providers to facilitate implementation of recommendations. Review claims involving complex or unusual services to determine medical necessity and payment accuracy. Develop alliances with the provider community through medical management programs. Represent the business unit before public and professional committees as needed. May work weekends and holidays to support operations. Education/Experience:
Medical Doctor or Doctor of Osteopathy. Experience in Utilization Management and knowledge of accreditation standards preferred. Active medical practice required. Coursework in Health Administration, Financing, Insurance, or Personnel Management is advantageous. Experience with diverse populations preferred. License/Certifications:
Board certification by the American Board of Psychiatry and Neurology. Current Washington state medical license without restrictions. Compensation & Benefits:
Pay Range: $231,900.00 - $440,500.00 per year. Benefits include competitive pay, health insurance, 401K, stock plans, tuition reimbursement, paid time off, holidays, and flexible work arrangements. Actual pay may vary based on skills, experience, and other factors. Total compensation may include incentives. Additional Information:
Centene is an equal opportunity employer committed to diversity. All qualified applicants will be considered without regard to race, religion, gender, sexual orientation, gender identity, national origin, disability, veteran status, or other protected characteristics. Qualified applicants with criminal records will be considered in accordance with applicable laws. #J-18808-Ljbffr